![]() ![]() Ponce S, Jennings A, Madias N, Harrington J.Fatal drug reactions among medical inpatients. Hyperkalemia in patients in the hospital. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, eds. PoIn: Adams JG, Barton ED, Collings JL, DeBlieux PM, Gisondi MA, Nadel ES, eds. Treatment and prevention of hyperkalemia in adults. 2,3 Topics:Ĭardiology, hyperkalemia, electrocardiogram, ECG, peaked T waves, widened QRS. 4,5,8,9 Treatment for hyperkalemia generally includes IV insulin and IV dextrose and nebulized albuterol for intracellular shift of potassium, IV furosemide and IV fluids for dilution and renal excretion of furosemide, and IV calcium for stabilization of cardiac membranes. 4-8 Impaired kidney function is the most common risk factor found in 33-83% of affected patients. While the incidence of hyperkalemia in the general population is not defined, the incidence in hospitalized patients is 1.3-10%. 1 In this particular case, labs showed a potassium of 7.6-mmol/L after initial treatment (see repeat EKG). Patients may also experience systemic symptoms such as weakness or paralysis. 2,3 This can devolve into a wide complex rhythm, ventricular tachycardia, ventricular fibrillation, or asystole. Initially the T waves become peaked and the QRS complexes widen. 1 As potassium rises, several abnormalities can be identified on ECG. The etiology of hyperkalemia may be due to an acute insult such as crush injury, drug side effect, or in acute renal failure, but may also occur in the setting of a chronic insult such as chronic kidney disease. Follow-up ECG post-treatment shows narrowing of the QRS complexes and normalization of peaked T waves. These findings are consistent with hyperkalemia, which was promptly treated. Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. Initial ECG shows tall, peaked T waves, most prominently in V3 and V4, as well as QRS widening. ![]() An abnormal rhythm was noted on the cardiac monitor, and ECG was ordered. Due to frequent ED visits for chronic pain, patient had difficult vascular access and nursing was initially unable to obtain IV access. She had no known history of renal failure. She described the pain as a “12 out of 10” which woke her from sleep at 0200, one hour prior to arrival. A 34-year-old diabetic female presented to the emergency department with chest pain status-post AICD firing. ![]()
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